Price transparency: MDMC now details cost of surgery to patient

Wednesday, January 25, 2017

Jill Bock

SIKESTON -- Six months of work, testing and trials culminated Monday with a simple phone call from Missouri Delta Medical Center to a patient.

The hospital employee was reminding the patient about an upcoming scheduled service and together they completed the registration process. Now, on the day of the surgery, the patient could skip the front admissions office and go directly to the department where the surgery was to be performed.

But the call included more than just an opportunity to check-in. MDMC, in partnership with the Orlando, Fla.-based company PatientMatters, also was able to detail the costs of the upcoming surgery with the patient and his financial responsibilities.

"Most things you know what you are paying for when you buy them -- whether it is a car, or furniture or whatever. With healthcare, you just would go do it and never know what you were going to owe," Urhahn said.

Through PatientMatters, she continued, the hospital now has the technology to provide the cost information up front.

According to Mark Mancuso, site director for PatientMatters, patients will receive a price estimate based on the deductible they may have incurred so far and the contracted amount approved by the insurer for the procedure. MDMC can determine how much the patient's co-insurance will pay as well as other factors.

"This way we can inform the patient ahead of time of what their financial responsibility is and they can be prepared ahead of time," he said.

Through PatientMatters, hospital staff will now offer patients a variety of payment choices. If the cost of the procedure is not entirely covered by insurance, the patient will have the option of setting up a re-payment plan or there is even a zero-interest loan program with repayments scheduled over two- or four-year periods.

Implemented last fall, the repayment plans have proved popular and feasible for patients, Mancuso said, noting the average payment is $58 per month, typically over a 24-month period. Several of those taking out a zero-percent loan have paid off their balances early, he added.

What Mancuso said he likes about the partnership between PatientMatters and the hospital is the level of advocacy the hospital is now able to offer patients, particularly those with Medicare and no secondary coverage or those needing assistance obtaining Medicaid or other similar programs. PatientMatters at MDMC has hired April Lambert to work with patients to determine what other resources are available for them to assist with their medical costs.

Greg Carda, MDMC's vice president of finance, said he considers the advocacy one of the best aspects of the hospital's new program.

"We have dramatically increased the number of patients made eligible for assistance either through Medicaid or other programs and this all comes with no additional cost to the patient," Carda said. "It is a benefit they were eligible for but just weren't aware of or hadn't been able to take the time to apply for. With PatientMatters we do this for the patient."

While acknowledging some patients would rather not have a conversation about the cost of medical procedure, Carda said statistics support that satisfaction is higher for patients who are able to plan for their financial obligations ahead of time.

"A person is naturally apprehensive when you quote a big number to them, especially at the beginning of the year. However, once you apply the insurance company's discount and take it down to what their amount is, then when they hear that dollar amount if they say, well I can't afford that, that is OK. Now we can say the hospital has different options available for you. We are trying to work with the patient," Carda said.

MDMC's billing program and price transparency has already earned it national acknowledgement from the Healthcare Financial Management Association, which honored the local hospital as one of 100 adopters of the HFMA's Communication Best Practices.

Along with recipients such as Duke University's hospital and others, MDMC was the smallest medical facility to be honored, Carda said.

As patients become more familiar with the price transparency and billing options, Mancuso said many may begin taking advantage of contacting the Pre-Access Center at 573-472-7171 for an estimate.

Patients, who have the five-digit CPT Code provided by their doctor describing the procedure, can get an estimate on the cost.

Armed with more knowledge about their healthcare costs, Mancuso said patients are more likely to not cancel procedures. Also he said they are more likely to review their hospital statements.

Overall, he continued, the price transparency and billing changes seek to keep the patient first.

"When you are talking clinical versus financial, the push is for patients to be focused on their clinical care and not so much worried about their financial health," he said. "This is an effort to bring those two worlds together, so that way everybody knows what their part is."